Liew Yee Kent

Sengkang General Hospital,
Singapore

Abstract Title: Inferior STEMI Mimic from Atrial Ectopic Rhythm with Atrial Repolarization Wave

Biography: Dr Liew Yee Kent completed his medical undergraduate studies at National University of Malaysia in 2013. He subsequently obtained the Master of Medicine (Emergency Medicine) in 2023 and completed his training in Emergency Medicine Residency Program in 2025. Dr Liew also earned the fellowship from the Royal College of Emergency Medicine of United Kingdom in 2025. He has a keen interest in emergency cardiology and medical education.

Research Interest: The atrial repolarization wave is rarely seen on ECG and has been described in case reports as a mimic of inferior ST-elevation myocardial infarction (STEMI). We present a case of left-sided chest pain associated with an atrial ectopic rhythm and prominent atrial repolarization waves, raising concern for inferior STEMI. A 69-year-old male with a 50 pack-year smoking history and known chronic obstructive pulmonary disease presented with recurrent left-sided chest pain and diaphoresis at rest. The initial ECG in the emergency department demonstrated an atrial ectopic rhythm with ST-segment elevation in the inferior leads and ST-segment depression in the lateral leads. A repeat ECG showed a slight increase in ST-segment elevation, prompting urgent cardiac catheterization. Coronary angiography revealed normal coronary arteries, apart from mild stenosis in the mid left anterior descending artery. Troponin levels remained within normal limits. The patient subsequently had spontaneous rhythm conversion to sinus rhythm, with complete resolution of ST-segment changes on ECG. This case highlights the importance of recognizing atrial ectopic rhythm with atrial repolarization waves as a potential mimic of inferior STEMI, which may help avoid unnecessary invasive procedures.